Sac Size Research Articles

Engineered Sensor Zebrafish for Fast Detection and Real-Time Tracking of Apoptosis at Single-Cell Resolution in Live Animals.

Apoptosis plays crucial roles during development and in disease conditions. While there are some methods to detect apoptosis in vitro, most of them are end-point assays that cannot be used to detect apoptosis in the physiological context of live animals. In this study, transgenic sensor zebrafish were generated that specifically produce a fluorescence resonance energy transfer (FRET)-based biosensor in the zebrafish skin. Under normal conditions, the skin cells of the sensor zebrafish emit green fluorescence; when caspase-3 is activated during apoptosis, the skin cells of the sensor zebrafish switch to emitting blue fluorescence. Through time-lapse FRET imaging with the sensor zebrafish, we observed that caspase-3 can be activated within 5 min and apoptosis can be completed in around 30 min in live zebrafish, no matter the apoptosis occurs several hours after UV irradiation or during the normal development. Using the sensor zebrafish, we found that apoptosis can occur in different parts of the zebrafish skin including the skin covering the trunk, eye, yolk sac, and head during development. Interestingly, we observed that the yolk sac diameter of the zebrafish reduced from 723.8 ± 25.1 μm at 24 h postfertilization (hpf) to 346.1 ± 24.6 μm at 120 hpf. To accommodate this dramatic reduction of the yolk sac size, we found that some excess skin cells on the surface of the yolk sac were removed by apoptosis during this process. The sensor zebrafish provide a powerful and convenient tool for the noninvasive and real-time detection of apoptosis at the single-cell resolution in live zebrafish.

Utility of percutaneous thrombin injection for treating visceral pseudoaneurysms

Purpose To assess the efficacy and outcome of percutaneous thrombin injection in treatment of visceral arterial pseudoaneurysms (PAs) in a selective group of patients. Material and methods Retrospective review of the institutional database showed 19 cases of visceral arterial pseudoaneurysms that were treated with percutaneous ultrasound-guided thrombin injection between January 2014 and December 2019 (13 men and 6 women). Of the pseudoaneurysms, 36% were due to pancreatitis, 35% were iatrogenic, 21% were infective and 8% traumatic. Most of the pseudoaneurysms arose from the hepatic artery (27%) followed by the splenic artery (26%) and renal artery (21%). Mean sac size of the pseudoaneurysms was 23 mm (range, 8 –40 mm). Technical success was defined as absence of flow within the PAs on follow-up ultrasonography (USG) 24 h and 3 days after thrombin injection. Results Overall technical success was seen in 10/19 patients. Technical success of thrombin injection was higher in cases of distal branch PAs as compared to main vessel PAs (9/13 vs. 1/6). Success rates were higher with smaller (<23mm) pseudoaneurysms (7/12) as compared to larger ones (3/7). There were no procedure-related complications. Conclusion Ultrasound-guided percutaneous thrombin injection is a novel method of treating visceral pseudoaneurysms as a painless, cheap and radiation-free procedure. However, further large-scale studies are needed to prove the efficacy in treating visceral pseudoaneurysms

Risk factors, presentation and outcome of meningomyelocele repair.

Objective:To determine the risk factors, presentation and outcome of meningomyelocele repairMethods:We reviewed 150 cases operated for meningomyelocele (MMC) at Jinnah Postgraduate Medical Centre Karachi between May 2015 and May 2018. Data of infants operated for MMC repair was extracted including socioeconomic status, maternal folate intake during pregnancy, head circumference, location and width of the defect, accompanying bladder and limb anomalies and treatments administered. Patients were followed up for a mean period of six months.Results:A total of 150 children were evaluated, out of which there were 83(55.3%) males and 67(44.7%) females. All belonged to low socio economic group and prenatal maternal folate intake as risk factor was positive in 103(68.7%) cases. Mean head circumference was 37.4 cm (range, 30.7 to 50 cm). Based on their location, 83(55%) of the defects were lumbosacral, 38(25.4%) were lumbar, 16(10.7%) were thoraco lumbar, 10(6.7%) were thoracic and three (2%) were cervical. Mean size of the meningomyelocele sac was 4.3 cm×5.6 cm (range, 1cm×2 cm to 11cm×8.4cm) and 21(14%) of the babies had a skin defect requiring flap. According to accompanying anomalies, 98(65.3%) of the babies had hydrocephalus, 13(9%) had club foot, four (2.7%) had diastematomyelia and three (2%) had tethered cord. Eighty seven (58%) patients had neurological deficit pre operatively and eight (5.4%) patients with normal power deteriorated after surgery out of which five (3.3%) developed paraplegia and three (2%) developed paraparesis. CSF leak was the major complication encountered in 16(11%) followed by meningitis in seven (5%), while the overall mortality was four (2.6%).Conclusion:The practice of periconceptional folic acid supplementation is essential to reduce the prevalence of neural tube defects (NTDs) in the developing world. Improved maternal nutrition with access to quality antenatal care is vital to decrease the prevalence and health burden.

Comparison of Computed Tomography Angiography (CTA) Findings in Post-Endovascular Aortic Aneurysm Repair CTA between Persistent and Transient Type II Endoleak

Objective: To compare first post-endovascular aortic aneurysm repair (EVAR) computed tomography angiography (CTA) imaging characteristics between transient and persistent type II endoleaks. Methods: This retrospective study enrolled patients who underwent EVAR and were diagnosed with type II endoleak from first post-operative CTA during January 2005 to October 2017 at the Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Aneurysmal sac size, aneurysmal sac growth, and endoleak were recorded among patients whose endoleak disappeared within 6 months (transient group), and among patients whose endoleak persisted for more than 6 months (persistent group). Results: Eighty-eight patients with a mean age of 75.3±7.3 years were included. Of those, 12 and 76 patients were in the transient group and persistent group, respectively. There were 71 males and 17 females. Univariate analysis showed number of feeding arteries (odds ratio [OR]: 9.9, p =0.012) and presence of inferior mesenteric artery (IMA) as an endoleak source (OR: 4.3, p =0.026) to be found more frequently in the persistent group than in the transient group; however, neither factor survived multivariate analysis. No significant difference between two groups was seen for endoleak diameter, endoleak complexity, or aneurysmal sac enlargement. Conclusion: The number of feeder arteries and presence of IMA as an endoleak source on first postoperative CTA to be more likely found in patients with persistent type II endoleak. Further prospective study in a larger study population is necessary to identify any existing statistically significant differences and/or associations.

Multicenter experience in translumbar type II endoleak treatment in the hybrid room with needle trajectory planning and fusion guidance

ObjectiveThe objective of this study was to evaluate the efficacy of treating type II endoleaks (T2Ls) after aortic endovascular repair with image guidance translumbar puncture using intraoperative cone beam computed tomography with preprocedure computed tomography angiography fusion in hybrid operating rooms. MethodsTwenty-six consecutive T2L patients in three different institutions were treated between March 2015 and September 2017 by direct translumbar puncture of the abdominal aortic aneurysm (AAA) sac after previous endovascular aortic repair. All patients were treated at a single setting in a cardiovascular hybrid operating room with a workstation featuring needle trajectory planning and guidance software. Aneurysm sac size change from the index treatment, freedom from recurrent endoleak after treatment, demographics, risk factors, and procedure factors were analyzed with univariate analysis. ResultsAll patients (N = 26; 19 male, 7 female; age range, 59-95 years; mean body mass index, 27.44 ± 3.06 kg/m2) underwent treatment for AAA sac expansion or symptoms. Four patients had failed to respond to previous catheter-directed T2L treatment. The most common risk factors included hypertension, hypercholesterolemia, coronary artery disease, tobacco use, and diabetes. Time to initial endoleak diagnosis ranged from 2 to 1914 days (average, 404 days). Aneurysm size after initial repair was 60.3 ± 7.5 mm; sac size had increased 10.1 ± 6.5 mm at the time of treatment. Onyx (Medtronic, Irvine, Calif) or glue (n-butyl cyanoacrylate) and coil embolization was used in 20 cases, and 6 patients were treated with coiling alone. There was no difference between the patients treated with coils alone and those treated with coils or glue (P > .05) in terms of freedom from failure. Total procedure time was 75.9 ± 40.7 minutes; contrast material volume, 19.9 ± 29 mL; fluoroscopy time, 13.74 ± 12.2 minutes; and radiation dose, 121.16 ± 167.7 mGy. After embolization, the mean sac diameter decreased by 2.2 mm to 67.5 ± 9.8 mm. Average follow-up period was 214 days. In 19 patients, the sac reduced in size between 0.2 and 19.1 mm per 100 days; in 2 patients, there was continued AAA expansion (3.4-4.3 mm per 100 days); there was no change in the sac size in 5 patients after the procedure. There were no AAA ruptures during the study period. Once T2L was treated, the recurrence rate was low at 11.5%. ConclusionsThis initial multicenter evaluation of the effectiveness of fusion image-guided translumbar obliteration of T2L demonstrated that the technique was effective at all three study centers and showed excellent efficacy to reduce AAA sac size. This may become a more effective and efficient method of treating T2L compared with transarterial or transcaval embolization because of its high success rate and technical ease.

Ultrasound-guided thrombin injection versus ultrasound-guided compression therapy of iatrogenic femoral false aneurysms: Single center experience

BackgroundIatrogenic femoral pseudoaneurysm (false aneurysm) due to arterial access following cardiovascular procedures is becoming common because of the increase in number and complexity of the procedures. Recently, percutaneous thrombin injection is becoming a popular treatment of these false aneurysms.The aim of this study was to assess the efficacy and safety of femoral pseudoaneurysm closure using ultrasound-guided thrombin injection in comparison to ultrasound-guided compression. MethodsA retrospective analysis was undertaken of 65 patients who presented to our vascular department with iatrogenic femoral pseudoaneurysm between January 2015 and March 2019. Twenty-five patients underwent ultrasound-guided thrombin injection, and 40 were treated using ultrasound-guided compression therapy. The primary outcome measured was efficacy, while other outcomes examined were safety, procedure duration, and cost. ResultsA total of 65 patients (45 males, 20 female) were identified with a mean age of 62 years. Out of the 65, 40 patients (28 males, 12 female) underwent ultrasound-guided compression therapy (group A) with a mean aneurysm size of 2.9 cm, and 25 (17 male, 8 female) underwent ultrasound-guided thrombin injection (group B) with a mean pseudoaneurysm sac size of 3.7 cm. The success rate of thrombosis in group A was 70% and in group B was 92%. No significant complications were reported in both groups. ConclusionsUltrasound-guided thrombin injection should be considered as the first line of treatment for uncomplicated femoral pseudoaneurysms because it has a higher thrombosis and lower recurrence rates, when compared with ultrasound-guided compression treatment.

The impacts of seasonal variation on the immune status of Nile tilapia larvae and their response to different immunostimulants feed additives

Few data are available on the thermal tolerance of Nile tilapia fish larvae in relation to their immune status and survival. The aims of this work were to evaluate the immune status of one day old Nile tilapia (Oreochromis niloticus) larval stage collected at the beginning (March), middle (August) and at the end (October) of hatching season through morphometric assessment of the larvae parameters including yolk sac diameter, body length and width as well as the expression of some immune-related genes (rag, sacs and tlr), inflammatory (il1b and il8) and stress related genes (hsp27, hsp70). Also, to compare the effect of three different immunostimulants (β-glucan, Vitamin C, and methionine/lysine amino acids mix) on the expression of the studied genes at two variant temperatures (23 ± 1 °C and 30 ± 1 °C) in experimental study for 21 days. The immune status of Nile tilapia is affected by thermal fluctuation throughout the hatching season reflected by altered yolk sac size, length, and expression of the immune and stress related genes of the larvae, the best performances was observed at the beginning of the hatching season (March). High temperature (30 °C) suppress immune and stress responses throughout downregulation of all the genes under study, mask any effects for the immunostimulants, increased mortality in fish larvae suggesting narrow thermal tolerance range for the larvae compared with the adult fish.We recommend the use of amino acid mix as immunostimulant for Nile tilapia larvae, it reduces the mortality percentage and improve cellular response. Also, the use of β-glucan should be prohibited during this developmental stage of larvae, it induced the highest mortality percentage.

Significance of Preoperative Thrombus Burden in the Prediction of Persistent Type Iiendoleak and Re-intervention Following Infra-renal Evar

Introduction: Persistent Type II Endoleak (PE II) has necessitated prolonged surveillance and requirement of re-intervention following infra-renal endovascular aneurysm repair (EVAR). The aim of this study was to assess the association of the percentage of aneurysmal sac thrombus (ST) with the incidence of PE II & subsequent re-intervention. Methods: Study included all consecutive patients undergoing infra-renal EVAR from October 2009 to October 2017 in a single vascular centre. ST was assessed on preoperative CT angiogram (CTA) and was defined as a percentage of thrombus across the maximal sac diameter in comparison to the luminal diameter, measured orthogonally at the same level. Patients were categorised into 3 groups; Group 1 (< 25% ST), Group 2 (25%-50% ST) and Group 3 (>50% ST). All patients underwent postoperative EVAR surveillance, which comprised of CTA or duplex ultrasound. The scans were assessed for PE II, which was defined as type II endoleak persistent for more than 1 year post-procedure. GraphPad Prism8 was used for analysis with Fisher's exact test & Student's T-test being used to determine significance. Results: Some 275 EVARs were performed in the study period. 45 procedures were excluded due to either iliac-only intervention (n=9), no pre-operative information (n=7), abandoned (n=1) or less than 1 years follow-up data (n=28). For the 230 procedures included, the median follow-up was 43 months (12-102 months); Group 1 (N=90), Group 2 (N=94) and Group 3 (n=46). There were no significant differences between the groups respectively for mean age (75 vs. 75 vs. 76 years); gender (male 88/90 vs. 89/94 vs. 43/46) and mean preoperative sac diameter (63mm vs. 65mm vs. 66mm). PE II occurred more frequently in Group 1 when compared to Group 2 and Group 3 [41% (n/N=37/90)vs.21% (n/N=20/94) vs. 4.3% (n/N=2/46), OR 2.6 (1.4 - 4.9)p=0.004and OR 15.4 (3.5-67.3) p=0.0003] respectively. Re-intervention was performed more frequently in Group 1 compared to Group 2 and Group 3 [11% (n/N=10/90) vs. 3.2% (n/N=3/94) vs. 0% (n/N=0/46) respectively, OR 3.8 (1.0 - 14.3) p=0.048) and OR 12.1 (0.69-211) p=0.09]. Sac size reduction was significantly greater in Groups 2 and 3 when compared to Group 1; -24% and 27% vs. -15% (p=0.009 andp=0.0002). Conclusion: Less than 25% thrombus is associated with increased incidence of PE II, reduced sac size reduction & increased re-intervention rates. Pre-emptive treatment could be considered in these patients whilst those with higher ST could be offered less frequent surveillance. Disclosure: Nothing to disclose

Contrast Enhanced Ultrasound Detects Endoleak after EVAR

Introduction - The major complications of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) include endoleak, stentgraft migration and increased aneurysm sac size with subsequent risk of rupture. Thus, EVAR requires lifetime follow-up. Contrast-enhanced computed tomographic angiography (CTA) is considered the gold standard in follow-up after EVAR. However, repeat CTA is potentially harmful due to accumulated radiation1; and the association between contrast agents and reduced renal function. Contrast agents used in contrast-enhanced ultrasound (CEUS) are not nephrotoxic and CEUS has been reported to be able to detect endoleak after EVAR2. The aim of this study was to investigate the preciseness of CEUS vs CTA in follow-up after EVAR. Methods - Ninety-two patients (79 men) operated with EVAR for AAA between Jan 2013 and May 2016 was prospectively, consecutively enrolled. Mean age was 74 years (range 57 – 92). Follow-up was done with CTA and CEUS at one, six, 12 and 24 months. At each follow-up, CTA and CEUS were done the same day. The results from CTA were blinded from the operator doing CEUS and vice versa. A GE Logiq E9 ultrasound machine and an abdominal curvilinear 2-5MHz probe were used for the CEUS. The ultrasound contrast agent used in this study was SonoVue® (2.4ml dispersion intravenous bolus dose). The presence of endoleak was registered as a dichotomous variable and CTA was defined as the gold standard. Statistical analyses were done using crosstabs and chi-square tests (IBM, SPSS Statistics v24). Results - 236 paired CEUS and CTA were performed. In total, 48 endoleaks were documented on CTA. The overall sensitivity of CEUS was 89 % and the specificity 100 %. The number of endoleaks detected at one, six, 12 and 24 months postoperatively are listed in Table 1. At six months, five new endoleaks were found on CTA and two with CEUS. At 12 and 24 months, no new cases of endoleak were detected by either modality. In all four cases of endoleak detected on CTA but missed on CEUS, poor visualization on CEUS due to high body mass index (median 30.5) was reported. All cases of endoleaks were type 2.Table 1Number of patients with paired CTA and CEUS performed during follow-up and the sensitivity and specificity of endoleak detection by CEUSFollow-up, monthsPatients (n)Endoleaks on CEUS vs CTASensitivity (%)Specificity (%)17311/129210066813/1776100126312/1210010024326/6100100 Open table in a new tab Conclusion - In the present study, CEUS showed high sensitivity and specificity for detecting endoleak. CEUS may replace CTA in most patients during follow-up after EVAR.

Simple renal cyst and its association with sac shrinkage after endovascular aneurysm repair for abdominal aortic aneurysms

ObjectivePatients with abdominal aortic aneurysm (AAA) frequently have simple renal cyst (SRC), a common manifestation of connective tissue degeneration. This study aimed to determine whether SRC is a risk factor for failure of sac shrinkage after endovascular aneurysm repair (EVAR). MethodsBetween October 2013 and May 2017, there were 155 consecutive patients with an infrarenal AAA or a common iliac artery aneurysm who underwent EVAR with the GORE C3 Excluder (W. L. Gore & Associates, Flagstaff, Ariz) at Tokyo Medical University Hospital. All these patients were registered in a prospectively maintained database. Any kidney lesion >5 mm in diameter, with no evidence of contrast enhancement or septation and with low attenuation, was defined as SRC. A change in sac size of >5 mm from baseline was considered significant. The patients were divided into those with SRC and those without SRC, and sac shrinkage at 1 year and 2 years was compared. The presence of SRC was assessed with respect to being a risk factor for failure of sac shrinkage at 1 year using univariate and multivariable logistic regression analysis. ResultsThe patients were divided into two groups: those with SRC (92 patients [59.0%]) and those without SRC (63 patients [41.0%]). At 1 year and 2 years, significant differences were observed in the proportion of sac shrinkage between patients with SRC and those without SRC (19.2% vs 42.4% [P = .003] and 19.6% vs 53.3% [P = .001], respectively). Patients with SRC showed significantly less sac shrinkage than those without SRC at 1 year and 2 years (−2.0 ± 5.5 mm vs −4.4 ± 6.2 mm [P = .002] and −1.8 ± 6.3 mm vs −6.4 ± 8.6 mm [P = .005], respectively). Multivariable analysis demonstrated that SRC (odds ratio, 0.28; 95% confidence interval, 0.12-0.63; P = .002) and initial sac size (odds ratio, 1.05; 95% confidence interval, 1.01-1.09; P = .027) were positive and negative risk factors for sac shrinkage, respectively. ConclusionsThe presence of SRC is a risk factor for failure of sac shrinkage after EVAR. This suggests that AAA in patients with SRC has a more degenerated wall than in those without SRC. The property of the aneurysm wall may be associated with sac shrinkage after EVAR.

Instabilities in Aortic Length After TEVAR and Reoperation: 12 Years of Follow-Up Imaging

Thoracic endovascular aortic repair (TEVAR) remains an important minimally invasive tool for the treatment of descending thoracic aneurysm. The long-term effects of these repairs in reduction of the aneurysmal sac size as well as stability of the stented portion require study. We report the results of 12 years of radiographic follow-up. All patients who underwent TEVAR for descending thoracic aneurysms from January 2005 to December 2017(n= 371) were evaluated for immediate postoperative and follow-up computed tomographic scans suitable for 3-dimensional reconstruction of the aorta (excluding those with an interim reoperation). We found 62 patients who met these criteria (median duration of radiographic follow-up, 1.8 years). Measurements were taken of centerline, greater and lesser curvatures from the most distal patent brachiocephalic vessel to the first uncovered mesenteric vessel, and between proximal and distal edges of the stented portion of the aorta. All measured segments, except covered length, were significantly increasing in length for centerline, greater and lesser curvatures, with a median increase of 7.6mm (interquartile range, 1.7-16 mm). Cox regression formortality and reoperation found no significant correlationbetween these changes and mortality and a significant correlation between stented segment greater curvature increaseand reoperation (adjusted hazard ratio, 1.06; P < .05). Increases in the centerline and greater curve length of the aorta were found to be occurring. This appears to be primarily driven by growth in the nonstented segments. However, changes in the outer curve length of the stented segment were associated with a greater risk of reoperation.

Embolization using hydrogel-coated coils for pulmonary arteriovenous malformations

PurposeTo prospectively evaluate the efficacy and safety of embolization using hydrogel-coated coils for the treatment of pulmonary arteriovenous malformations (PAVMs). Materials and methodsThe outcomes of 21 PAVMs in 19 patients (3 men and 16 women; mean age, 58.8±15.2 [SD] years; age range 14–78 years) treated by venous sac embolization (VSE) with additional feeding artery embolization were prospectively evaluated. For VSE, using one or more 0.018-inch hydrogel-coated coils was mandatory. Recanalization and/or reperfusion were evaluated by pulmonary arteriography 1 year after embolization. ResultsThe mean feeding artery and venous sac sizes were 4.0mm and 8.5mm, respectively. Embolization was successfully completed in 20/21 PAVMs, yielding a technical success rate of 95%. The feeding artery was also embolized in 17/20 successful PAVMs (85%). A technical failure occurred in one PAVM, where embolization was abandoned because of migration of one bare coil to the left ventricle. The mean numbers of hydrogel-coated coils and bare platinum detachable coils used for VSE were 3.3±2.1 (SD) (range, 1–8) and 4.4±3.9 (SD) (range, 1–17), respectively. The mean percentages of hydrogel-coated coils in number, length, and estimated volume were 42.9%, 33.3%, and 72.7% respectively. One patient with one PAVM was lost to follow-up after 3 months. Neither recanalization nor reperfusion was noted in the remaining 19 PAVMs (success rate, 19/19 [100%]). One grade 4 (coil migration) adverse event occurred, and it was treated without any sequelae. ConclusionVSE using hydrogel-coated coils with additional feeding artery embolization is a safe and effective treatment for PAVM.

Correlation Between Dural Sac Size in Dynamic Magnetic Resonance Imaging and Clinical Symptoms in Patients with Lumbar Spinal Stenosis

To assess the dynamic change of the dural sac size in patients with lumbar spinal stenosis (LSS) from supine to standing position and their correlation with clinical symptoms. A total of 110 patients with LSS were prospectively enrolled to undergo both supine (0°) and standing (78°) magnetic resonance imaging (MRI). Dural sac cross-sectional area (DCSA) and dural sac anteroposterior diameter (DAPD) at the most constricted spinal level in supine and standing MRI were measured and compared. Clinical symptoms were assessed by duration of disease, claudication distance, visual analog scale (VAS) score of leg pain, and Chinese Oswestry Disability Index score of low back pain. The correlation between the parameters and clinical symptoms was analyzed by Pearson correlation coefficient (r). Mean minimum DCSA and DAPD in the standing position were significantly smaller (both P < 0.01) than in the supine position. DCSA and DAPD in standing MRI and their changes had better correlation with the intermittent claudication distance and VAS score of leg pain than in the supine position. A more than 15 mm2 reduction of DSCA was observed in patients with shorter claudication distance and more severe VAS score of leg pain (both P < 0.01). Dural sac size on MRI was reduced significantly from supine to standing position. Standing MRI and the changes of DCSA significantly correlated with claudication distance and VAS score of leg pain in patients with LSS. Therefore, standing MRI provides more radiologic information correlating with clinical symptoms in patients with LSS than supine MRI.

A comparison of clinical outcomes of abdominal aortic aneurysm patients with favorable and hostile neck angulation treated by endovascular repair with the Treovance stent graft

ObjectiveThe objective of this study was to compare outcomes of patients with favorable neck angulation (FNA) and hostile neck angulation (HNA) treated with the Treovance stent graft (Terumo Aortic [formerly Bolton Medical], Sunrise, Fla). MethodsPatients with abdominal aortic aneurysms suitable for endovascular repair with Treovance were included in the RATIONALE postmarket surveillance registry. A post hoc subgroup analysis compared patients with infrarenal neck angles <60 degrees (FNA) and ≥60 degrees (HNA). ResultsAfter 1 year, 179 FNA (89.5%) and 21 HNA (10.5%) patients were analyzed. Both groups were similar in terms of sex (male, 92.7% FNA and 95.2% HNA) and age (73.0 years vs 72.6 years), but the HNA group had more Asian or other race representation (7.3% vs 19.0%) and more patients assigned to American Society of Anesthesiologists class 3 and class 4 (57.6% vs 66.7%). Mean suprarenal angles (standard deviation) were 13.1 (±13.5) degrees vs 29.0 (±16.4) degrees; mean infrarenal angles were 23.2 (±16.4) degrees vs 65.4 (±4.6) degrees, respectively. Aneurysm sac size maximum diameter was 58.1 (±9.8) mm vs 62.0 (±14.1) mm. There was a significant difference in unplanned adjunctive procedures (2.2% vs 19.0%; P = .01). Mean procedural duration was also significantly different for HNA patients, who underwent protracted operations (111.3 [±47.3] minutes vs 153.5 [±44.5] minutes; P < .0001). However, there were no significant differences in rates of clinical success (96.1% vs 95.2%). The rate of reintervention was low overall but 0% in the HNA group. Changes in sac size at 1 year were significant in both groups but not as pronounced in HNA patients (relative change of −11.8% [±13.3] vs −6.6% [±11.4]). ConclusionsPatients with high neck angulation treated with Treovance underwent more complex procedures but showed equally good technical success and 1-year clinical success parameters.

Lipid storage consumption and feeding ability of Calanus glacialis Jaschnov, 1955 males

Calanus is one of the best studied genera of Arctic zooplankton, but still we know very little about the males since they are short-lived and mainly present in winter. Their short life-span compared to females is assumed to be a combination of high mating activity, no feeding and consequential depletion of lipid stores. In this study we tested 1) if the life span of male Calanus glacialis is limited by their lipid storage reserves and 2) if males are capable of feeding and utilize food if present. We ran two separate experiments from January to March; one on starvation and one on feeding. In the 39-days long starvation experiment we followed the lipid sac size of individually incubated males until their time of death. On average the total lipid (TL) content decreased by 2.6 to 4.5 μg day−1, but despite this males had substantial amounts of lipids left (131.4 μg, SD 44.0) when they died. This strongly suggests that the depletion of lipid reserves is not the main reason for males' short life span which in this study was measured to be up to 73 days. In the feeding experiment, we fed both C. glacialis males and females ad libitum with 13C labelled microalgae. Both males and females were capable of feeding and assimilate the diatom monoculture, but females responded faster to the sudden favourable food conditions, and produced more and larger fecal pellets than the males. Assimilation of 13C labelled 20:5(n-3), an essential polyunsaturated fatty acid (PUFA), from the diatom diet was traceable in both males and females on day 21, and then with a higher enrichment in females than males. Morphological investigations of the feeding appendages showed some differences between sexes, suggesting males to be more omnivorous than females. In conclusion, lipid storage depletion is not the cause of death for male C. glacialis, and males may even compensate for some of the mating energy costs by feeding. In future, we recommend further studies on the role of essential fatty acids (FA) for sperm formation and aging as determining factors for males' relatively short life span.

1904 Laparoscopy Combined with Hysteroscopy in the Treatment of Cesarean Scar Pregnancy

Video Objective To introduce a treatment of Cesarean Scar Pregnancy. Setting Patient information:Age:34y.Chief complaint:pregnancy at 10 weeks and a little vaginal bleeding for 20 days. Past history:underwent two cesarean sections in 7 years ago and 5 years ago ;received removal of CSP by hysteroscopy after uterine artery embolization last year. No other special past history.Investigation information: 1.B-ultrasound: sac size: 41*27*35mm, fetal heart (+), the sac locates on the cesarean scar. 2.MRI: the thickness of cesarean scar is less than 2mm. 3.HCG:103722mIU/ml.Diagnosis: Cesarean scar pregnancy(CSP Type II) Interventions Laparoscopy combined with hysteroscopy to remove the CSP and repair the uterine,the innovative point is to temporary interrup the bloodstream by knotting a slipknot around both uterina arterys during the operation and remove the knots at last of the operation. Conclusion The removal the CSP and repair the uterine through laparoscopy combined with hysteroscopy is a minimally invasive surgery which will help patient to recover rapidly.Temporary interrup the bloodstream by knotting a slipknot around both uterina arterys during the operation and remove the knots at last of the operation that will reduce the bleeding during the operation effectively.This kind of surgery is expected to be a good way to treat CSP type II and type III. To introduce a treatment of Cesarean Scar Pregnancy. Patient information:Age:34y.Chief complaint:pregnancy at 10 weeks and a little vaginal bleeding for 20 days. Past history:underwent two cesarean sections in 7 years ago and 5 years ago ;received removal of CSP by hysteroscopy after uterine artery embolization last year. No other special past history.Investigation information: 1.B-ultrasound: sac size: 41*27*35mm, fetal heart (+), the sac locates on the cesarean scar. 2.MRI: the thickness of cesarean scar is less than 2mm. 3.HCG:103722mIU/ml.Diagnosis: Cesarean scar pregnancy(CSP Type II) Laparoscopy combined with hysteroscopy to remove the CSP and repair the uterine,the innovative point is to temporary interrup the bloodstream by knotting a slipknot around both uterina arterys during the operation and remove the knots at last of the operation. The removal the CSP and repair the uterine through laparoscopy combined with hysteroscopy is a minimally invasive surgery which will help patient to recover rapidly.Temporary interrup the bloodstream by knotting a slipknot around both uterina arterys during the operation and remove the knots at last of the operation that will reduce the bleeding during the operation effectively.This kind of surgery is expected to be a good way to treat CSP type II and type III.

Velocities of type II endoleaks on Doppler ultrasonography predict outcome

ObjectiveWe sought to determine whether flow velocities measured using Doppler ultrasonography after endovascular aortic aneurysm repair (EVAR) can predict for resolution of type II endoleaks without intervention. We also assessed the relationship of the flow velocities to sac growth and the need for intervention. We hypothesized that hemodynamic properties suggesting low flow velocity would predict for resolution of type II endoleaks. MethodsThe data from 23 patients with type II endoleaks identified on Doppler ultrasonography after EVAR from January 2014 to December 2017 were retrospectively analyzed. The 23 patients with type II endoleaks were split into two groups. Group 1 included the 13 patients with resolved endoleaks or shrinking sac size and group 2, the 10 patients with an increasing sac size or those requiring intervention to seal the endoleak because of an increased sac size. We analyzed the velocities of the endoleak nidus. ResultsDoppler ultrasound velocities were significantly lower in patients with resolved type II endoleaks and those with a shrinking aneurysm sac size compared with those demonstrating an increase in aneurysm sac size (42.6 ± 25.2 cm/s vs 219.5 ± 84.1 cm/s; P < .0001). Of the 10 patients in group 2, nine had required intervention with either translumbar embolization or transarterial embolization, with only two experiencing complete resolution of the type II endoleak, despite the intervention. All patients in group 2 had had ≥1 duplex ultrasound scan with endoleak nidus velocities >100 cm/s. In contrast, no patient in group 1 had had any duplex ultrasound scan with endoleak nidus velocities >100 cm/s. ConclusionsThe Doppler ultrasound velocities of type II endoleaks might be able to predict for spontaneous resolution of type II endoleaks or increased sac growth. Type II endoleaks on Doppler ultrasonography with endoleak nidus velocities >100 cm/s can persistent, even with attempted treatment.

Fate of Pure Type II Endoleaks Following Endovascular Aneurysm Repair.

PurposeType II endoleaks (T2ELs) are the most common type of endoleaks observed after endovascular aneurysm repair (EVAR). However, whether T2ELs should be treated remains debatable. In the present study, we aimed to describe the natural course of T2ELs and suggest the direction of their management.Materials and MethodsWe reviewed the data of 383 patients who underwent EVAR between 2007 and 2016. Data, including demographic and anatomical details, were collected, and patients with T2ELs were compared to those without them. Patients with T2ELs were categorized into subgroups according to changes in sac size and treatment requirement.ResultsWe found patent lumbar artery count and lesser thickness of mural thrombi to be significant risk factors for T2ELs. Among the 383 patients, 85 (22.2%) patients were diagnosed with pure T2ELs. Among these 85 patients, the sac size increased in 29 (34.1%) patients, showed no significant change in 39 (45.9%) patients, and decreased in 17 (20.0%) patients. Fifteen (17.6%) patients, among 85 with initial pure T2ELs, showed spontaneous resolution. Five (5.9%) patients among 29, in whom the sac size increased, developed combined-type endoleaks. No sac ruptures were noted among the patients with T2ELs.ConclusionT2ELs with sac expansion potentially contribute to other types of endoleaks. Therefore, periodic screening is important for these patients, particularly for those showing an increasing sac size. In addition, intervention should be considered when other types of endoleaks occur.

S22THE EFFECT OF ALCOHOL ON THE GUT MICROBIOME OF PREGNANT WOMEN

Cadmium is a persistent contaminant of surface waters. The effects of cadmium on early life stages of fish are not well understood, although they are often disproportionately affected by contaminants. The objectives of this study were to examine effects of chronic exposure to environmentally relevant concentrations on growth, development, cellular stress, and glucose metabolism of channel catfish, Ictalurus punctatus. Eggs were wet-fertilized in treatment water at concentrations of 0.4 (control), 2.2 (low), or 8.5 (high) μg L−1 and monitored through swim-up, black fry stage. Eggs and fry accumulated cadmium dose-dependently. Fertilization rates were unaffected, yet hatch rate was significantly reduced in the high treatment. Survival to black fry and overall size and condition factor were not affected; however, differences in yolk sac size, and presumably energetics of yolk fry, was detected. Physiological pathways were also affected, demonstrated by altered gene expression, most notably in genes related to carbohydrate metabolism. Elevated expression of HK and G6PD, rather than G6P and GADPH, suggests glucose may be shunted towards the pentose-phosphate pathway. Overall, observations indicate cadmium negatively affects development in early life stages of channel catfish, which could lead to shifts in population structure and life history patterns in exposed populations of wild fish.

Enchancement of Toremifene Anti-Tumor Action by Metformin and Unusual Side Effect of Toremifene in Male Transgenic Mice with HER2-Positive Breast Tumor.

HER2-positive breast tumors are found in 25-30% of patients with breast cancer and are characterized by aggressive course and reduced sensitivity to both chemotherapy and hormone therapy. The aim of the work was to study the possibilities of enhancing the therapeutic effect of anti-estrogen drug toremifene by combining it with biguanide, metformin, on the HER2-positive breast cancer model in FVB/N HER-2/neu transgenic mouse. Male FBV/N mice with intramuscularly transplanted HER2-positive mammary gland tumor from a female mouse of the same strain have been given toremifene (30 mg/kg, orally daily) or metformin (100 mg/kg, orally daily) that had a moderate antitumor effect (decrease the area under the kinetic curve of tumor growth by 1.6 and 1.5 times, respectively, when compared with intact control). Co-administration of these drugs in the same doses had a more pronounced effect (the area under the kinetic curve of tumor growth decreased by 3.1 times compared to intact control; p<0.05). After 10 days, in group receiving toremifene all 10 mice developed inguinal-scrotal hernias, and in group that received toremifene plus metformin - only 5 of 10 (p=0.0325). By the 15th day after the start of treatment, the hernias was also determined in all mice treated with the combination of toremifene and metformin, but the size of the hernial sac was significantly smaller than in those receiving only toremifene - 537 ± 96 mm3 and 1309 ± 120 mm3, respectively (p=0.0001). A possible explanation is the manifestation of collagen-degrading effect of toremifene.